A new nomogram to identify patients eligible for extended pelvic lymph-node dissection during radical prostatectomy on the basis of target biopsy findings only

You have accessJournal of UrologyProstate Cancer: Staging (MP11)1 Sep 2021MP11-20 A NEW NOMOGRAM TO IDENTIFY PATIENTS ELIGIBLE FOR EXTENDED PELVIC LYMPH-NODE DISSECTION DURING RADICAL PROSTATECTOMY ON THE BASIS OF TARGET BIOPSY FINDINGS ONLY Enrico Checcucci, Cristian Fiori, Ilaria Stura, Daniele Amparore, Sabrina De Cillis, Angela Pecoraro, Paolo Alessio, Alberto Piana, Federico Piramide, Gabriele Volpi, Paolo Verri, Stefano Granato, Beatrice Carbonaro, Davide Zamengo, Agostino De Pascale, Dario Gned, Matteo Manfredi, Giuseppe Migliaretti, and Francesco Porpiglia Enrico CheccucciEnrico Checcucci More articles by this author , Cristian FioriCristian Fiori More articles by this author , Ilaria SturaIlaria Stura More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Paolo AlessioPaolo Alessio More articles by this author , Alberto PianaAlberto Piana More articles by this author , Federico PiramideFederico Piramide More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Paolo VerriPaolo Verri More articles by this author , Stefano GranatoStefano Granato More articles by this author , Beatrice CarbonaroBeatrice Carbonaro More articles by this author , Davide ZamengoDavide Zamengo More articles by this author , Agostino De PascaleAgostino De Pascale More articles by this author , Dario GnedDario Gned More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Giuseppe MigliarettiGiuseppe Migliaretti More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001984.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nowadays, the role of synchronous pelvic extended lymphadenectomy (ePLND) during prostatectomy for prostate cancer still remains discussed. Various different tools aiming to identify patients who will benefit from ePLND are available such as mp-MRI. However, also other instruments such as nomograms, can help the surgeon during the decision-making process in case of positive target biopsy (TB) alone. The aim of our study was to develop a novel model based on mp-MRI findings and TB alone in order to predict the risk of Lymph Node Invasion (LNI). METHODS: We retrospectively extracted from our prospectively maintained database patients with preoperative positive mp-MRI and TB who underwent robotic prostatectomy with ePLND from April 2014 to March 2020. A logistic regression model was performed to evaluate the impact of pre- and intra-operative factors on the risk of LNI. The results are shown in terms of Odds Ratio (OR) with a 95% Confidence Interval (95%CI). Model discrimination was assessed using an area under curve (AUC), the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of LNI based on the logistic model was generated. The proposed model cut-off was chosen maximizing both sensitivity and Youden score. RESULTS: Overall, 461 patients were included in our study; among them 52 (11.27%) had LNI. At logistic regression DRE, MRI findings (organ confined vs ECE, vs SVI), PI-RADS, seminal vesicle invasion, PSA and worst GS at I and II target lesions were significant predictors of LNI. At multivariable model, DRE (OR 0.56; C.I.: 0.30-1.05) and SVI (OR: 0.42; C.I.: 0.19-0.93) were the most significant variables, followed by PSA (OR: 0.30; C.I.: 0.21-0.73) and worst GS at I (OR: 0.37; C.I.: 0.17-0.82) and II target lesion (OR: 0.33; C.I.: 0.14-0.76). The AUC was 0.74 [0.67-0.81] 95% CI. This predictive model was subsequently transformed into a visual nomogram, as shown in Figure 1. The cut-off to discriminate LNI risk was set with a Youden index of 60 points, corresponding to a LIN risk of 7%. CONCLUSIONS: The results of our study demonstrate that ePLND can be avoided in patients with positive TB only, being the risk of LNI below 7%, in order to spare approximately 59.1% of ePLNDs at the cost of missing only 4.7% positive LNs. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e187-e187 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enrico Checcucci More articles by this author Cristian Fiori More articles by this author Ilaria Stura More articles by this author Daniele Amparore More articles by this author Sabrina De Cillis More articles by this author Angela Pecoraro More articles by this author Paolo Alessio More articles by this author Alberto Piana More articles by this author Federico Piramide More articles by this author Gabriele Volpi More articles by this author Paolo Verri More articles by this author Stefano Granato More articles by this author Beatrice Carbonaro More articles by this author Davide Zamengo More articles by this author Agostino De Pascale More articles by this author Dario Gned More articles by this author Matteo Manfredi More articles by this author Giuseppe Migliaretti More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement Loading ...